JAMA

Beware heightened bleeding risk when diltiazem used with DOACs

May 17, 2024

Among Medicare patients with atrial fibrillation (afib) being treated with apixaban or rivaroxaban, concomitant use of diltiazem was associated with greater risk of serious bleeding than metoprolol, particularly for diltiazem doses >120 mg/day.

• This retrospective cohort study included 204,155 patients (mean age, 76.9 years; 52.7% female) with afib who initiated apixaban or rivaroxaban and also started diltiazem (n=53,275) or metoprolol (n=150,880) between January 2012 and November 2020. Patients were followed for up to 365 days (median, 120 days). Primary outcome was a composite of bleeding-related hospitalization and death with recent evidence of bleeding.
• Diltiazem recipients had an increased risk for the primary outcome (rate difference [RD], 10.6 per 1,000 patient-years [PY]; hazard ratio [HR], 1.21) and its components of bleeding-related hospitalization (RD, 8.2 per 1,000 PY; HR, 1.22) and death with recent evidence of bleeding (RD, 2.4 per 1,000 PY; HR, 1.19) compared with metoprolol recipients. Risk for the primary outcome with initial diltiazem doses >120 mg/day was greater than that for lower doses. Risk of major ischemic or hemorrhagic events was higher for doses >120 mg/day. When patients receiving high and low doses of diltiazem were directly compared, HR for the primary outcome was 1.14.

Source:

Ray WA, et al. (2024, April 15). JAMA. Serious Bleeding in Patients With Atrial Fibrillation Using Diltiazem With Apixaban or Rivaroxaban. https://pubmed.ncbi.nlm.nih.gov/38619832/